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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206636
Report Date: 11/29/2022
Date Signed: 11/29/2022 10:18:23 AM

Document Has Been Signed on 11/29/2022 10:18 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:DIAZ CARE HOME 3FACILITY NUMBER:
547206636
ADMINISTRATOR:GARDUNO, VANESSAFACILITY TYPE:
735
ADDRESS:2313 S. JACQUES STTELEPHONE:
(559) 738-1072
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: 6DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Vanessa Garduno, AdministratorTIME COMPLETED:
10:30 AM
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On 11/29/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and meet with the Vanessa Garduno, Administrator. No clients were present during the inspection.

LPA conducted tour with Administrator. Facility staff was observed with mask on. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing and cough etiquette postings observed in facility. Hand sanitizer was readily available to clients and visitors. Social distancing is maintained in the common and dining areas.

LPA observed fire extinguisher served date: 12/21/21. Food supply was checked and appeared to be an adequate supply. Medications were kept in a locked closet and observed a 30-day PPE supplies. Cleaning supplies were stored and locked in garage and laundry room. LPA observed hand washing posting by all sinks. All bathrooms are observed with trash cans with lid. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 1 shared resident’s bedroom to be at least 6 feet apart and 4 bedrooms that are single occupant.

Staff records were reviewed for good health and infection control training. All residents’ records reviewed to have updated emergency contact information. The exterior tour was conducted. Side gate was self-closing and free of obstruction.

No deficiencies issued during this inspection.

Exit Interview conducted. The following forms were requested: LIC 308, LIC 400, LIC 402, LIC 500, LIC 610D. LPA received copy of Current Administrator Certificate and Lic 503. Please submit the above forms/information to Fresno CCL by: 12/05/22. A copy of this report was provided to Administrator.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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